Engagement Pattern: How ABA chains lift commercial collections.
What a typical commercial-payer recovery engagement looks like for a multi-site ABA chain transitioning from generic billing to specialty-aware RCM.
The starting state
This is the typical state of an operation before we engage. If most of these apply to you, the engagement pattern likely applies too.
- Multi-site ABA chain, mix of commercial (BCBS, Aetna, UHC, Cigna) and Medicaid
- Generic billing vendor without ABA payer-specific medical-necessity templates
- First-pass denial rate above industry benchmark (industry good is under 12 percent)
- Commercial collections lagging Medicaid collections, despite commercial fee schedules being 1.3x to 1.8x higher
- Authorization tracking in shared spreadsheets with no owner
The intervention
What a senior ASP-RCM partner runs in the first 30 to 90 days. The audit is week one. The fixes get prioritized by recoverable dollars per week of effort.
- Senior partner runs the 47-point operational audit + payer-specific gap analysis
- ABA-specific medical-necessity documentation templates wired into the EMR for each top commercial payer
- Pre-bill scrubbing rules built around the specific CARC + payer pairs driving denials
- Authorization workflow rebuilt with named owner per clinic and 30/60/90 day rolling expiration tracking
- Denial work queue Pareto-sorted by recoverable dollars per CARC + payer combination
- BCBA credentialing tracker installed with target under 90 days per the APBA national benchmark
Outcomes we typically see
Ranges from across engagements with this profile. Where industry benchmarks exist (BHCOE, APBA, HFMA, HBMA), we calibrate to those.
- First-pass acceptance lifted into the 88 to 94 percent range (industry good is above 92)
- Commercial collections lift typically materializes within 60 to 120 days of go-live
- Aged AR over 90 days falls into single digits as legacy backlog is worked down
- BCBA credentialing time compresses toward the 60 to 75 day range
- Net collection rate stabilizes in the high 90s for in-network commercial
What to bring to the first conversation
If you want a senior partner to walk through your specific numbers against this pattern, here is what makes the conversation immediately useful.
- Last 90 days of 835 remittance files
- Current AR aging report by clinic and payer
- Active authorization log (whatever format you use)
- Top 10 denial CARC list from your clearinghouse
- Credentialing tracker if you have one
30 minutes with a senior partner.
Free. Written 4-page report. No SDR triage. No obligation.